Key Takeaways

During his career as a litigator, Milwaukee-based lawyer Jeffrey Gingold, 55, would often find himself facing a judge and jury with his client’s fate in his hands. “I had to have every bit of the client's information, the case, and the law on the tip of my tongue at all times,” he says.

But this became somewhat challenging for Gingold because of the multiple sclerosis (MS) symptoms he experienced, particularly the cognitive ones.

According to the National Multiple Sclerosis Society (NMSS), as many as half of all people with MS experience problems with learning and remembering information, organizing and problem-solving, and being able to focus their attention.

Gingold, who was diagnosed with MS in his thirties, stopped practicing law in 2001 because of cognitive issues.

Understanding MS Cognitive Impairment

“This is a very real issue for many people with MS,” says Robert W. Charlson, MD, assistant professor in the departments of neurology and psychiatry at the NYU Langone Medical Center and a psychiatrist with its Multiple Sclerosis Comprehensive Care Center in New York City.

"It is separate from depression, mood issues, and fatigue that can accompany MS and affect concentration. Those conditions can make concentration issues worse, but we are talking about a separate entity in and of itself,” Dr. Charlson says.

MS-related attention problems are also different from more common attention problems, says Nicholas LaRocca, PhD, vice president of health care delivery and policy research at the National MS Society. “What you don’t typically see in MS is a simple inability to focus,” Dr. LaRocca says.

Instead, MS-related attention problems are often related to multitasking or to quickly switching the attention back and forth between competing thoughts or tasks. For example, people with MS can become extremely distracted if someone talks to them while they are doing household chores.

This type of cognitive problem can arise for several reasons, LaRocca says. "Most important is the fact that the ability to process information is often slowed in MS. In addition, due to short-term memory problems, they can lose their train of thought and momentarily forget where they were in a task."

“People with MS develop plaques in their brain that interfere with the brain’s ability to communicate with other parts of the brain,” says Norton Winer, MD, division chief of neurology at UH Regional Hospitals’ Richmond Campus in Ohio and assistant clinical professor of neurology at the Case Western Reserve University School of Medicine in Cleveland. “We think these connections get knocked out by damage from MS.”

9 Tips for Staying Focused

If you have attention problems associated with MS, try these expert-recommended tips to help stay focused:

Gingold takes that one step further. “MS wiped out any ability I had to multitask, which can be as simple as having a conversation with several people at the dinner table to as complicated as trying to do something on the computer,” he says. “Instead of trying to do several things at once, make a list of each task you have to do, and complete one at a time.”

Minimize distractions. “Try to create an environment that allows you to be as distraction-free as possible,” says Rosalind Kalb, PhD, vice president of the professional resource center at the NMSS. Find a quiet place to do work, keep eye contact with people you are talking with, and turn off the television and remove other stimulation when you need to focus, Dr. Kalb advises.

Get plenty of sleep. Fatigue impacts your cognitive functioning, so make sure you get sufficient rest. “If you are deprived of sleep, you may have trouble with all sorts of tasks, and obviously attention as well,” LaRocca says. Work with your healthcare team to learn strategies to minimize disruptions in your sleep.

Know your limits. “And don’t test them,” Dr. Winer says. “I tell patients they have a neurologic reserve, so if they are going 500 miles an hour, they should take two steps back to avoid burning out.” Put another way, set aside time to rest and recharge. “In MS, the cognitive cloudiness is telling you that your brain is tired,” Winer says.

Take precautions when driving. “When you are driving a car, you’ve got stimulation coming into every sense,” Kalb says. “A person with MS who has attention problems has real difficulty putting all of that together.” She advises turning off the radio, minimizing any other distractions, and staying focused on where you're going and how you're going to get there.

Choose a “safe” person. “Whether it’s a friend or spouse or grown child, find someone who understands what you are dealing with so when you have a [difficult] moment, you don’t need to explain,” Gingold says. His wife and children, ages 18 and 21, are his safe people.

Exercise. Physical activity may lead to small yet appreciable improvements in cognition, fatigue, depression, and overall quality of life, according to a review article in the September 2015 issue of Current Neurology and Neuroscience Reports. Talk with your doctor about the most appropriate exercise plan for you, Charlson says.

Consider getting cognitive help. There are cognitive rehabilitation programs that can help improve the ability to focus for people with MS, Charlson says. Participants learn about daily planning and pacing to function better, he says. Ask your neurologist for recommendations.

Treat the MS. “We know that we can help with disease symptoms, decrease relapses, and make the brain scans look better with MS treatment,” Winer says. “It's been hard to show any effect on the brain or in the preservation of cognitive function, but we think these drugs are helpful for cognition.”

Charlson adds that diagnosing and treating depression in MS can also make a difference and may have spillover benefits into cognitive issues.